{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T13:52:42Z","timestamp":1761659562834,"version":"build-2065373602"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Direct\u2010acting antivirals (DAAs) have dramatically improved sustained virological response (SVR) rates in patients with hepatitis C virus (HCV) infection. However, the risk of hepatocellular carcinoma (HCC) remains even after achieving SVR. We previously reported that alpha\u2010fetoprotein (AFP) levels at the end of treatment (EOT) were associated with the occurrence of HCC after achieving sustained virologic response (SVR). Here, to improve predictive accuracy by incorporating the Agile 3+ score among 502 patients who received DAA therapy for HCV infection between September 2017 and July 2024, we excluded those who developed HCC within 1\u2009year of treatment and included 337 patients with chronic hepatitis or compensated cirrhosis, who had no prior HCC and underwent transient elastography before treatment. A scoring system was developed by assigning 1 point for Agile 3+ score \u2265\u20090.9398 and 1 point for EOT\u2010AFP \u2265\u20093.8\u2009ng\/mL. The cumulative HCC incidence was analyzed in relation to the total score. Cox proportional hazards models were used to assess independent risk factors. During follow\u2010up, 15 patients (4.5%) developed HCC. Patients with a score of \u2265\u20091 had a significantly higher HCC risk (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Agile 3\u2010AFP score \u2265\u20091 (hazard ratio (HR) 12.65, 95% CI 1.38\u2013115.49,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) and GGT (HR 1.00, 95% CI 1.00\u20131.01,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) remained independent predictors of HCC occurrence. A simple scoring system combining the pretreatment Agile 3+ score and EOT\u2010AFP levels may be useful for long\u2010term risk stratification of HCC after DAA therapy in HCV\u2010infected patients.\n                  <\/jats:p>","DOI":"10.1002\/jgh3.70296","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T09:57:19Z","timestamp":1761127039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of Hepatocellular Carcinoma After Direct\u2010Acting Antiviral Therapy Using Agile 3+ and End\u2010of\u2010Treatment Alpha\u2010Fetoprotein Levels in Patients With Hepatitis C"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9397-8056","authenticated-orcid":false,"given":"Akifumi","family":"Kuwano","sequence":"first","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1129-5380","authenticated-orcid":false,"given":"Masayoshi","family":"Yada","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"},{"name":"Department of Gastroenterology Ichinomiyanishi Hospital  Ichinomiya Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taikan","family":"Hamomoto","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuki","family":"Kurosaka","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideo","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Motomura","sequence":"additional","affiliation":[{"name":"Department of Hepatology Aso Iizuka Hospital  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(16)30181\u20109"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy585"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.06.012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1716"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i24.2582"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30823"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.02.046"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2018.10.014"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)32111\u20101"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13993"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000513705"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.05.021"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000694"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202211_30400"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2020.11341"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13625"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000604"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27366"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21669"},{"key":"e_1_2_10_21_1","first-page":"S257","article-title":"Development and Validation of Agile 3+: Novel FibroScan Based Score for the Diagnosis of Advanced Fibrosis in Patients With Nonalcoholic Fatty Liver Disease","volume":"75","author":"Younossi Z. 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